Validation of the Hierarchical Nature of the AO Spine Sacral Classification and the Development of the Sacral AO Spine Injury Score.

Authors

• Brian A Karamian
• Gregory D Schroeder
• Mark J Lambrechts
• Jose A Canseco
• Emiliano N Vialle
• Frank Kandziora
• Lorin M Benneker
• Rajasekaran Shanmuganathan
• F Cumhur Öner
• Klaus J Schnake
• Christopher K Kepler
• Alexander R Vaccaro

Publication/Presentation Date

7-1-2023

Abstract

STUDY DESIGN: Global cross-sectional survey.

OBJECTIVE: The objective of this study was to validate the hierarchical nature of the AO Spine Sacral Classification System and develop an injury scoring system.

SUMMARY OF BACKGROUND DATA: Although substantial interobserver and intraobserver reliability of the AO Spine Sacral Classification System has been established, the hierarchical nature of the classification has yet to be validated.

METHODS: Respondents numerically graded each variable within the classification system for severity. Based on the results, a Sacral AO Spine Injury Score (AOSIS) was developed.

RESULTS: A total of 142 responses were received. The classification exhibited a hierarchical Injury Severity Score (ISS) progression (A1: 8 to C3: 95) with few exceptions. Subtypes B1 and B2 fractures showed no significant difference in ISS (B1 43.9 vs. B2 43.4, P =0.362). In addition, the transitions A3→B1 and B3→C0 represent significant decreases in ISS (A3 66.3 vs. B1 43.9, P < 0.001; B3 64.2 vs. C0 46.4, P < 0.001). Accordingly, A1 injury was assigned a score of 0. A2 and A3 received scores of 1 and 3 points, respectively. Posterior pelvic injuries B1 and B2 both received a score of 2. B3 received a score of 3 points. C0, C1, C2, and C3 received scores of 2, 3, 5, and 6 points, respectively. The scores assigned to neurological modifiers N0, N1, N2, N3, and NX were 0, 1, 2, 4, and 3, respectively. Case-specific modifiers M1, M2, M3, and M4 received scores of 0, 0, 1, and 2 points, respectively.

CONCLUSIONS: The results of this study validate the hierarchical nature of the AO Spine Sacral Classification System. The Sacral AOSIS sets the foundation for further studies to develop a universally accepted treatment algorithm for the treatment of complex sacral injuries.

LEVEL OF EVIDENCE: Level IV-Diagnostic.

Volume

36

Issue

6

First Page

239

Last Page

239

ISSN

2380-0194

Published In/Presented At

Karamian, B. A., Schroeder, G. D., Lambrechts, M. J., Canseco, J. A., Vialle, E. N., Kandziora, F., Benneker, L. M., Shanmuganathan, R., Öner, F. C., Schnake, K. J., Kepler, C. K., Vaccaro, A. R., & AO Spine Sacral Classification Group Members (2023). Validation of the Hierarchical Nature of the AO Spine Sacral Classification and the Development of the Sacral AO Spine Injury Score. Clinical spine surgery, 36(6), E239–E246. https://doi.org/10.1097/BSD.0000000000001437

Disciplines

Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods

PubMedID

36864585

Department(s)

Administration and Leadership

Document Type

Article